Supraglottic Airway in the Pediatric ICU Airway Management

Sunday, March 22, 2026

12:15 PM - 1:15 PM Central Time

Location: Connections Central - RST 12

Muhammad Hamad, MD (he/him/his)

Children's Hospital of Philadelphia, EGY

Disclosure(s): No relevant financial relationship(s) to disclose.
MP

Matthew Pinto, MD

Associate Clinical Professor of Pediatrics
Maria Fareri Children's Hospital At Westchester Medical Center

Disclosure information not submitted.
Natalie Napolitano, PhD, MPH, RRT (she/her/hers)

Children's Hospital of Philadelphia, Pennsylvania

Disclosure information not submitted.
VN

Vinay Nadkarni, MD, MS, FCCM

University of Pennsylvania Perelman School of Medicine

Disclosure information not submitted.
Akira Nishisaki, MD, MSCE (he/him/his)

Childrens Hospital of Philadelphia, Pennsylvania

Disclosure information not submitted.

Introduction: Supraglottic airway such as laryngeal mask airway (LMA) is advocated for difficult airway management. Landscape of LMA use is not reported across PICUs. We hypothesize LMA use is rare, more used in larger patients and in patients with difficult airway features. We also hypothesize that LMA used as a rescue device (LMA rescue cohort), compared with LMA as a primary device (LMA primary), is associated with higher occurrence of adverse airway outcomes (AAO): tracheal intubation associated events and/or oxygen desaturation (>20% lower than baseline).

Methods: National Emergency Airway Registry for Children database was queried from April 2018 to March 2025. Inclusion criteria are PICU intubations, placement of new airway, and LMA or laryngoscope as airway device. Primary outcome was AAO. Fisher’s exact and multivariable logistic regression with 95% confidence interval (CI).

Results: Among 20,621 patients and 22,009 airway courses, LMA use was reported in 117 (0.57%) patients and 140 courses (0.64%); 84 patients (0.41%) as LMA primary and 33 (0.16%) as LMA rescue cohort. Both primary and rescue LMA cohorts were older (median age, primary 4 yr, rescue 7 yr) vs. laryngoscopy cohort (2 y),p=0.019. Primary and rescue LMA cohorts had higher proportion of difficult airway history (primary 38%, rescue 33% vs. 10%, p< 0.001), and difficult airway features (43%, 54% vs. 20%, p< 0.001). Shock as indication was more common in the rescue LMA cohort (primary 11%, rescue 23% vs. 13%,p=0.302). LMA placement was successful as a primary device in 92% of airway courses, and as a rescue device in 78%. AAOs were more frequent in primary and rescue LMA cohorts (primary 33%, rescue 67% vs. 24%, p< 0.001). After adjusting for age, difficult airway feature, and indication, primary and rescue LMA cohorts had higher likelihood of AAOs (primary: aOR 1.78, 95% CI 1.12-2.85, rescue: aOR 6.19, 95% CI 2.97-12.90) vs. laryngoscopy. Rescue LMA cohort had significantly higher odds for AAOs vs. primary LMA (aOR 3.47, 95% CI 1.46-8.27,p=0.005).

Conclusions: In PICUs, LMA use is rare, more used in larger patients and in patients with difficult airway features. LMA rescue cohort (vs. LMA primary) was associated with higher occurrence of adverse outcomes. Proactive LMA use should be considered in high-risk pediatric airway management.